Tuesday, March 8, 2011

Welcome to the March Carnival of Natural Parenting: Natural Parenting Top 10 Lists

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Hobo Mama and Code Name: Mama. This month our participants have shared Top 10 lists on a wide variety of aspects of attachment parenting and natural living. Please read to the end to find a list of links to the other carnival participants.

Top 10 reasons to choose midwifery care

One of our fabulous midwives (the one with us through our labor) with a grumpy-looking newborn Mikko

I want to write this post not because I think everyone can or should choose midwifery care, but just to put out what I feel are my top reasons for doing so, and why it might also be a good choice for you to consider if you're in a low-risk pregnancy (which is most pregnancies, fortunately).

I should be clear that I live in the United States in Washington state, so the midwives I'm talking about are independent licensed midwives (LMs, also called CPMs for certified professional midwives) who do not work in hospital institutions and instead offer only birth center and home births. I'm not going to talk about midwifery care in other countries and states, not because I'm unaware of some of the differences but because I'm not qualified to speak knowledgeably. Also: Not all midwives are created equal (same with physicians); I fully realize some pregnancies and births require a more intense level of medical care; and this is not intended as some sort of bashing of other choices. These are simply my generalizations from one and a half pregnancies and one birth (so far) with two different sets of midwives.

With Mikko, I saw midwives throughout the pregnancy and had planned a home birth but ended up transferring to a hospital after 39 hours of labor, at which point my midwife and the student midwives with her moved into the role of doula and I still had my natural birth a few hours later, but in a different location. This pregnancy, so far so good — we're seeing a midwife (a different one this time, because our previous midwives are on an extended break — one of them decided to have a baby, if you can believe it) and planning a home birth that will hopefully stay at home this time.

1. Midwives treat you like a person first.

Midwives don't see pregnancy as a disease, so they don't see you as a problem to be solved or managed. They want to know your particular history and story, and they listen honestly and respectfully to your plans for pregnancy and birthing — not paying lip service to birth plans but truly considering any requests and requirements you have, and talking with you forthrightly about what they in turn feel comfortable with. I was afraid I'd be laughed at for wanting to do Hypnobabies and a water birth – no problem with midwives!

2. Midwives let you keep your clothes on.

For the initial consultation part of a visit, at least. There's no shuffling you off to a cold, sterile examination room by a nurse to put on a paper robe. Midwives personally greet you in a home-like office and wave you in for a comfortable seat to begin chatting. Midwives don't mind if you bring along your partner and your other children, because this is a family practice, and every member of the family has a voice. When it's time for an exam that does require any sort of nudity, you have your choice of how bare you want to be, and who remains in the room with you. One thing I really appreciated about my midwives' vaginal exams was that they were very cautious in how they approached it, giving you time to relax and adapt. They would tell you what was happening at every step, and they would touch your thigh first, telling you they were going to. Then they would gradually tap their way inward, so it wasn't a surprise that made you tense up. I thought that was so respectful, especially considering how many women I know who have trouble with pelvic exams due to discomfort and even distress over possible rough treatment.

3. Midwives give you more time. Lots more.

I've been steamed in the past to wait an hour and a half in a doctor's waiting room only to be granted a mere five minutes in the physician's august presence — and then billed 100 bucks for the privilege. My midwife visits last at least half an hour up to a full hour. You don't have to wait until your (or your doctor's) hand is on the doorknob to bring up the important points you wanted to ask, because everything you wanted to say will have plenty of opportunity to come out. I had a dermatologist who supposedly listened while I told him which acne drugs I was resistant to — and who then handed me an illegibly scrawled prescription that turned out to be for precisely that family of drugs. Midwives do you the courtesy of actually listening to you.

4. Midwives are cheaper.

This is true whether you have insurance or not, or whether or not your insurance covers midwifery care (though it's a shame if it doesn't). The midwives in our area charge about $2,000 cash for everything: prenatal office visits, home visits, birthing, postpartum care. Get a doctor or hospital to agree to that price! I realize midwives charge more or less in other areas, but I doubt any charge as much as a typical OB-attended pregnancy and birth — to say nothing of hospital stays and the prices of any interventions that are more likely to occur in a hospital setting. Our insurance does cover midwifery care, so I figure the insurance company is getting quite a bargain out of my choice. Along similar lines, I found I was able to control the cost of tests with midwives, since they would gladly answer any questions I had about the price of tests and procedures that were offered and were upfront about their own fees. Almost every doctor or hospital I've asked about the price of something has looked at me as if I had two heads — did they find it offensive that I brought up something as low-class as how much things cost, or did they simply have no idea because they never had to care? I left my gynecologist after she did an expensive STD test on me without my knowledge or consent — and I was stuck with the bill.

5. Midwives still make house calls.

It's true! My midwives last time (they were a partnership) each made a visit to our house in my third trimester to make sure they could find it for the homebirth. (Good thing, too, since one did take the wrong exit and got lost on the way!) One of them came over after the birth, too, to see how we were settling in and to help with breastfeeding initiation. And, obviously, if you're having a homebirth, they come to your home at any time of day or night and stay as long as they're needed!

6. Midwives believe in informed consent.

Midwives don't force you into "routine" tests and procedures. They give you verbal and written information about any choices you have to make, present their views — and then leave it to you to make the decision, as the patient or as the parent of the patient. Compare this with the fight I had with about ten nurses in the hospital over not giving my newborn the hep B shot, even though it was written in my chart; not only did they not explain the pros and cons of giving the vaccine to a baby, but they presented it in such a way that I was supposed to feel pressured into accepting. Good thing my midwife was still around to fend them off for me!

7. Midwives want you to have a healthy, natural birth.

If you have a dream of a low-intervention, gentle birth, midwives are for you, because they want the same thing. They are trained and have experience in techniques for getting you calmly through labor, without a lot of interference. They can suggest different positions and motions to try. That said, the "healthy" part of my subhead? That's important, too. Far from being recklessly bent on a natural-birth-or-nothing approach, midwives are interested in the same results anyone wants: healthy mother and healthy child.

8. Midwives are trained medical professionals.

That leads me to this next point. Midwives, at least the licensed ones around here, spend years in college and then midwifery school and then in hours of practical apprenticeship. They carry real medical equipment with them to any birth and use real medical equipment during prenatal visits. They know how to resuscitate newborns with breathing problems and have both medicine and techniques to stop postpartum bleeding. Mine gave me two bags of IV fluid during my labor because I was dehydrated. I remember when I was telling my parents that Mikko weighed 11 pounds, 13 ounces, at birth, my dad said it was a good thing we had had him weighed in the hospital or he wouldn't have believed the numbers — I had a glimpse into my dad's mind where he was probably imagining midwives hefting the baby in one hand and some rocks in another and saying, "He weighs the same as three swallows and seven dandelion bundles!" I mean, sure, some midwives are hippies — most midwives are at least a little hippy — but my midwives' scale was the same digital one as used in hospitals. Shocking! Midwives here are licensed and insured by people who will vouch that they are educated on anatomy and normal pregnancy and birth progressions — as well as when a mother or baby has an experience beyond what is safe to deal with in a birth center or home environment.

9. Midwives will work with other medical professionals respectfully.

If a transfer into more medicalized care becomes necessary or prudent during pregnancy, birth, or the postpartum period, a good midwife will be the first one to let you know. The aim of a responsible midwife isn't to be a natural-birth hero — it's to make sure everyone involved has a healthy outcome. I still sometimes second guess going along with my first midwife's suggestion that we transfer to the hospital after such a long labor with no apparent progress – but I know she had my best interests at heart and I understand her reasons for recommending it, because she explained them all to me and gave Sam and me time to digest and discuss before coming to our decision. My midwives had a good working relationship with the staff at a certain hospital, and one certified nurse-midwife (CNM, with hospital privileges) in particular, so they were able to transfer us there and call in the nurse-midwife in the middle of the night. My midwife and the students stayed with us to encourage and support us even in the hospital and were knowledgeable and gentle advocates with the staff.

10. Midwives can help you postpartum.

After our birth, my midwife stuck around the hospital long enough to watch us through the afterbirth tests and procedures — and then she needed to get some sleep, too! Our next couple days at the hospital were not so good. We had a rocky start to breastfeeding due to really bad advice a nurse foisted on us. Fortunately, we were finally discharged and allowed to settle in at home in our own bed, as I'd originally planned would happen immediately following the birth. My midwife, who is also a lactation consultant, came to check on us and see how things were going. She confirmed the progress of my physical healing and weighed Mikko (on a digital scale, Dad!) to see how well he was feeding. She was calm and level-headed and encouraging, informing me that my milk had come in and that I had no need to continue to go through the rigmarole of formula supplementation and pumping that the hospital had gotten us into — she made us confident that we would be able to breastfeed successfully, and soon. And she was right. She also gave us the support we needed to ignore the hospital nurse's insistence that we follow up immediately with a pediatrician, so we were able to cancel our next-day appointment that would have forced us out of our cozy cocoon and relax and enjoy our babymoon solitude a bit longer. And? As gentle as the midwives were with you during your pregnancy — that's how gentle they are with your baby, too. No roughness, no taking your little one away without your consent, but respect and tender handling, just the way you would touch your baby.

As I was writing these top ten reasons, even more sprang to mind! But I hope that gives you an idea of how much I appreciate and endorse midwifery care — and how sad I am when I hear that midwifery is discouraged or outright made illegal in some areas. I wish that everyone had access to the respectful, personal care that a midwife can give! I'm totally spoiled by my midwife experiences and have no wish to go back to physician care for as long as I can swing it. In fact, we chose a naturopath for Mikko's pediatrician so we could continue having a midwife-like experience.

Even though my first birth wasn't all I'd hoped, I am so grateful to have had midwifery care leading up to it and guiding me through it. If I'd been in a hospital, I'd have had a much harder time relaxing into my Hypnobabies techniques, and I wouldn't have had the same freedom to take walks on the beach and long, long showers. (There wasn't even a shower in my hospital bathroom!) A typical OB would have found a 42-hour labor unacceptably long and pressured me into other interventions. And, of course, if ultrasounds during my pregnancy (I had none, from my own choosing) had given a hint that Mikko was as large as he was, I'd have had a hard time convincing an OB not to give me a C-section! As it was, I was able to give birth vaginally without medication, without panic (until the horrific drive to the hospital!), and with a quick healing thereafter. I thank my midwives for the confidence and support they gave me throughout the pregnancy and birth, letting me know they believed my body was strong and made for carrying and birthing new life — and that they would be with me through it all.

The Midwives Model of Care, which starts with the reassuring statement that "pregnancy and birth are normal life processes." Read this to see if it resonates with what you desire from pregnancy and birth for you and your baby.

Top 10 Ways to Avoid a Time-Out — If you are uncomfortable using time-outs in an attempt to control your child's behavior, try one of these gentler alternatives. Dionna at Code Name: Mama shares her Top 10 Ways to Avoid a Time-Out.

My Top 10 Parenting Scriptures — Dulce de leche is learning to integrate faith and parenting. Whether it is breastfeeding, babywearing, comforting her children, or gentle discipline, she finds that the Bible has beautiful passages to encourage her on her journey.

Top 10 Nursing Positions / Situations — Momma Jorje uses her 5½ years of nursing experience to share her Top 10 Nursing Positions/Situations. She includes some adorable photos of her youngest daughter at the breast.

10 Family Systems and Routines That Work for Us — See what routines, organizational systems, and parenting approaches work for Kristin at Intrepid Murmurings to help avoid conflict and maintain sanity in a family with three young children.

Postpartum Gift Ideas — Alicia at I Found My Feet suggests a top 10 list of gifts for mother's after giving birth.

My Top Ten Shows Worthy Of Screen Time — Tree at Mom Grooves shares her top ten list of shows that she believes are positive, educational, kind, joyful, and a nice way to share some downtime with your children.

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comments:

Great post Lauren. I especially liked the line: "The aim of a responsible midwife isn't to be a natural-birth hero". That is so true.

I too had a fantastic midwife, but she was alligned with the local hospital, and I am so grateful that I only called her after about 30 hours of labour. As it was she only arrived at about 40 hours (she'd been at a different birth and I had my midwife-mom with me, so no one was worried). I didn't give birth for another 8 hours. Can you imagine if I'd called her at the first twinge?! As is, at 45 hours she told my hubby we'd have to start thinking about transferring as I was still only at 4cm and pushing!

He asked for two more hours, and in the end we had an incredible birth. It all worked at as it was meant to.

Great post - really good points, and I couldn't agree more. You have really made me want another baby!

What a fabulous post, Lauren! There are so many myths and misconceptions about midwives, and the information and encouragement you gave is invaluable. Also, I loved learning about Hypnobabies - that's a great idea! How wonderful that you give your babies such an awesome start in life! Deb @ LivingMontessoriNow.com

My first was a regular OB, and it was because of that experience we went with midwifery for our second. Wonderful experience and your post is excellent in saying all the reasons why :)!! 11pounds? 42 hours? You and Mikko both are amazing :).

I live in Toronto, Canada where midwives attend home births and hospital births. I have had the same midwife for 4 births and I sing her praises as often as I can! She was spectacular and there is no way that I could have accomplished 4 natural births (2 at home) without her skills and assistance.

What I learned from my midwife is that I am stronger than I would ever have believed I was. After my son's birth in July she said "So when are we doing this again?" Ha ha ha.

I miss my midwives! After having them for my first pregnancy and now seeing an MD (albeit a lovely one) for my second, I can see the drastic difference in practice starting with for prenatal care. I am so glad I have the information and confidence provided during my first pregnancy to stretch out to this one.

That's a great list. I saw a CNM (certified nuse midwife) for my planned homebirth and she came to my house for every prenatal visit. All the visits were nearly an hour long and the only vaginal exam she did was on my due date.

Yep, even though I ended up transferring and having a c-section, I am so happy I was under her care. I will be hiring her again for the next baby for sure.

I love that you said, "I want to write this post not because I think everyone can or should choose midwifery care, but just to put out what I feel are my top reasons for doing so, and why it might also be a good choice for you to consider."

I'm not sure midwife-only care would be for me, but I live in a state where midwives are ILLEGAL and I think that's horrible. Every woman should be given the opportunity to have the birth she wants.

Transferring care from my OB to my MW was the best decision I ever made. I totally agree that they "treat you like a person first." My midwives made me feel so comfortable and relaxed, something I hadn't felt while under the care of my OB. I think it's very important to be able to be comfortable and relaxed!

I have literally only seen midwives for my GYN-care. My mom switched to using midwives with my much-younger siblings, so when it came time for me to start getting annual checkups, it was only natural that I would see them - though those checkups are never totally comfortable, those first midwives I saw were awesome (just what you described) and even had nice pictures on the ceiling, which I think was a thoughtful touch. When I was pregnant with Ella, there was never even the consideration of getting an OB, I went with a great group of midwives and had a very nice med-free birth. I did not know midwifery was illegal in some states - not only is it a shame, it's a silly and misinformed policy! After all, midwifery has been around far longer than obs!

Yes--I love my midwife. If I had to go to an OB like I did for my first baby, pregnancy would be a real drain on me. It seems like every time I went in they wanted either my shirt or my pants off, or for me to trot down to the other end of the hospital for some test or other. I find that brand of prenatal care exhausting in and of itself! With my second daughter, my midwife didn't even see my vagina until my baby was coming out :-) And she won't again this time. Unfortunately, midwives here cost a bit more, and my insurance does NOT cover. Totally worth it anyway though, to give birth with a trusted FRIEND to help in a tub in my very own bedroom.

Fabulous post! As soon as the home pregnancy test showed positive, the first thing I did was call a CPM. It was a choice I will never regret. I also saw a hospital based CNM for shadow care and the difference between the practices was amazing. Homebirth midwives are the way to go! And your 11 lb chunk monkey is as cute as can be!

Great post! My mom had three homebirths with a midwife when I was a teenager, and I LOVED her midwife. She was like a member of the family. I have always wanted a homebirth, not least for that reason you mention, of not wanting a doctor's hands up my Lady Business every time I walk in the office. Sadly, I haven't had one yet (let myself get talked into a hospital birth last time), but next time we are definitely going with a homebirth!

Before I had the hospital birth, I thought homebirth was more of a luxury than anything important. But after the "purple pushing" the doctor insisted on, the aforementioned Lady Business will never be the same ... and the interference by the hospital lactation consultants set us up for months of breastfeeding difficulties. Next time I'm going to stand my ground and not let anyone make me do anything that I KNOW isn't evidence-based. Doctors can be so pushy sometimes! Whereas midwives are, as a whole, way more respectful of your autonomy.

Great post! I can't help but think that if I had been more informed before I had my son-if I had read things like this post back then-I might have chosen a midwife and not had to get a c-section. (Or at least wouldn't have been denied all food and drink other than water for 24hrs before I finally had my son. How's a body supposed to labor with no fuel!?)Anyway, Brava for getting this info out so mamas can make informed choices!

PS I'm so glad I decided to read the carnival posts even though I didn't get my act together and participate-I've already found two new blogs to bookmark and read regularly!

I love that they will even let plain old children in with you. With my first child I had an almost 4yo with me. He wasn't related but he was certain he was going to be a big brother, and was just as much part of the family. He was so excited when my midwife let him listen to the baby's heart beat and showed how the baby was laying. I am pregnant again and I almost had an extra 1yo when we went to interview a new midwife (old one moved out of state). And my niece niece is always tagging along, she is only 6 years younger than me. Family better be okay.

1. I've never seen any baby photos of Mikko. My God he was a doll then, too!

2. I LOVE the comment about weighing the same as swallows and dandelions. I really do think that's how a good portion of our population views midwifery.

3. I had a wonderful hospital birth. Low intervention, lots of "take your time," lots of room to do what I wanted, when I wanted. That said, if we have another, I'm definitely considering a midwife. My first experience wasn't bad, but should I be fortunate enough to have another I'd like to experience a midwife assisted home birth too.

I've had two very good experiences with midwifery care and one not-so-good experience. With both midwives that I had good experiences with, I never had to remove any clothes in their presence until I was actually in labour. They asked if I wanted to have a vaginal exam to check progress, rather than stating that the exam would take place as matter of fact.

The midwives I had a negative experience asked me to have a breast exam in the very first interview, and asked to do more invasive tests later on. Looking back on it now, I can see why I never felt very comfortable there.

Great post! I feel like choosing a midwife and home birth for my first baby was one of the most life-changing decisions I have ever made.

Amen! This is a very informative post. I could not birth without my current midwife. Well, that's not technically true. :-) But she's seriously amazing. I've actually moved over an hour from her, but I still plan on using her. She's sensitive to MY needs and sees me as an individual, not just another patient.

Thanks so much for helping spread awareness about midwives. I wish more moms were aware how they're not just for crunchies but that all women can benefit from their skillful and compassionate care.

I read the swallows and dandelions part out loud to great laughter among my family.

I was the first in my group of friends to go to midwives instead of the OB, but I wasn't the last. I *loved* my midwives for my first two births, and was dismayed to find myself somewhere without midwifery care for the third.

In the end, ONE midwife began practicing near us when I was 36 weeks pg, and she trained one of the local doulas to be the second at my birth, who has subsequently gone through midwifery training. One more homebirth for the books. Phew.

Fantastic post! Loved the follow up at the bottom too. I had midwives for both pregnancies and it was the best single decision I made towards having a natural birth. It is a WORLD of different from an OB/GYN. I met with an OB during my second pregnancy, before we decided to do a home birth and I was so upset afterwards. He didn't listen to me, or read me chart, i got a canned speech and had to wait almost 2 hours to see him. ALL the things you mentioned above. Our midwife was an hour drive away, but it was so totally worth it. She was exactly what we needed and we loved every minute that we got to spend with her. Thank you for writing this!

Yaaaay, midwives! I don't have much midwife experience, as I went to a normal OB for my first birth and was kicked OUT of my hospital-based midwife clinic once they found out I was having twins (I was fine with seeing perinatologists after that, actually, since I was worried about twin-to-twin transfusion syndrome and other complications).

But, if we ever have another baby, I am pretty sure I'd like to try midwives again. On hand I feel fairly comfortable with the hospital birthing environment at this point (neither experience was bad, my twin birth was pretty good) but I know a birth center or homebirth could be great! What are your thoughts on Seattle's hospital-based/connected midwives vs. the type you are seeing now? Just curious! Thanks for a great post!

So cool. As you know, we're TTC (though less focused on it now) and home birth has been on my mind. I see it as a real possibility next time around. However, I'm 38 & had GD during my last pregnancy. Still... I'm otherwise very healthy.

So, I hope I can do this. And lately it just seems like I keep stumbling upon more and more stuff about midwifery and home birthing. :-D

Since I just quit my FT job, I lost insurance. However, I did some research and found that my local Indian Clinic has a CNM! YAY!

This post hit me at such an important, and raw, time. My second babe was just born in a hospital, despite using midwifery care and planning a homebirth.

My heart is still heavy with the change in plan and the loss of the birth experience I wanted, but your post reminded me of all the reasons why I still am so happy about our choice to use a midwife. Not only did she provide excellent prenatal care but she also provided so much support as we transitioned settings.

I'm not sure if we'll have another but if we do, I'd like to think that we'd choose another midwife and try for homebirth one more time.

When you said "midwives give you more time," my mind automatically jumped to my own birth - where my midwives let me a) labor longer after my water started leaking than an OB would have, and b) let me labor longer period. A couple of weeks after Kieran was born, my midwife finally admitted to me that she was getting ready to talk to me about transferring to a hospital - I'm confident that I would have been sectioned if I labored in a hospital.I love, love, love midwives (in general). I hope that someday they are a realistic option for every woman in the US.Great list!!

He weighs the same as three swallows and seven dandelion bundles! ~hilarious!

Between you and Leslie, my next birth plan...shoot! My whole pregnancy will be different. Thanks for the informed and well written list. I have always loved the "idea" of a midwife but I have never actually considered it as a possibility for me. Maybe because of the stereotypes. Thanks for clearing the air :)

I had a midwife for both of my births. I would go so far as to say that the care I received should be the standard of care that ALL OBs should have to live up to.

My midwife fought for me every step of the way, helping me avoid an induction, mandatory fetal monitoring (I agreed to intermittent), and medication. I gave birth to both my babies using HypnoBirthing, and was able to actually push sitting up when it was time to get my Little Girl out. The kicker: I was a high risk pregnancy, and I still managed to have the delivery I wanted because she was willing to work with an OB collaboratively.

I can't say enough about her or my experience. (I have blogged about it, too.)

I had a midwife when I was first pregnant, but she stepped down when my proteinuria got too high and I had to see see a nephrologist and perinatologist. So I definitely got to see both sides of the picture. See a midwife was so nice, like you said--they are so respectful, calm, they give you LOTS of time. Going to the peri was SCARY. But to be fair, I never had to put a gown on for exams.

After my doc insisted on an induction and I was admitted to Labor and Delivery, my husband called my midwife to comfort me, and the amazing woman got my care changed back to the midwives (hospital midwives), and they saw me through my labor and delivery, with the doctors for backup--but we never needed them. I still had to have interventions, but I KNEW the midwives were fighting for the most natural birth possible for me, unlike the perinatologists that certainly would have been wheeling me off to the OR for a c-section. So, yeah, midwives are awesome.

Doctors are for special-case pregnancies and births, but midwives are the experts for normal pregnancies and births. They'll transfer your care to a medical professional if it goes out of their scope. I think women would be wise to choose a midwife first, if they can.

I had an obstetrician the first time and after I saw him once, I didn't want to see him again. I had to wait for over an hour and then he examined me and pushed me out of his office so quickly that I couldn't even begin to ask all my questions. I was lucky I didn't need to see him again and the second time I chose midwifery care, too. There was a big difference in treating you as a person without a doubt.

Great list. I had a midwife too and even though I ended up with a scheduled c-section because my son was breech, I was so glad. She was there with me for the whole thing and I was so grateful.

Where I am (BC) midwives have hospital privileges so they can go right in with you. But everyone assumed I wanted a home birth because I had chosen a midwife. I didn't - they just offer really good care (including 6 weeks of postpartum care here).

I am really lucky - we live in New Zealand which has midwifery led care, which means everyone uses midwives unless there is an issue which requires a referral to an OB, (or some people choose to pay privately for an OB but its pretty uncommon).Still though, I find you have to pick and choose carefully - just like with any health professional. My midwife is awesome - she's a specialised homebirth midwife with over 20yrs experience. I love her!

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Riding the rails with my husband, Crackerdog Sam, and our hobo kids, Mikko Lint Picker (born June 2007), Alrik Irontrousers (born May 2011), and Karsten (born October 2014). Trying every day to parent intentionally and with grace.